Tag Archives: Socioeconomic bias

What’s wrong with Romney’s Plan to just send more people to Emergency Rooms: Ethnic and racial disparities in Health Care – All Patients are Not Created Equal Disparities in Racial and Ethnic Medical Treatment

All patients are not created equal Many emergency departments and hospitals in low socioeconomic areas, sometimes referred to as “safety net hospitals,” have closed, resulting in serious problems for poor and minority populations due to reduced or no access to emergency care. This results in exacerbating illness or injury due to either waiting time to get, or failing to seek, medical attention. When patients later become desperate, ambulance calls increase; emergency rooms in distant hospitals become overcrowded; all resulting in further delayed emergency room care. Medical specialists have become more reluctant to be on-call out of concern for overburdened emergency…

Patient Access to Cancer Care and Proposed Medicare Budget Cuts – Press Release Bioethics

July 27, 2011 ASCO Urges Policymakers to Protect Patient Access to Cancer Care from Debt Ceiling Negotiation Package The American Society of Clinical Oncology (ASCO ) is deeply concerned about the proposed $3 billion in cuts to Medicare reimbursement as part of a debt ceiling negotiation package. If the cuts are put into place, patient access to cancer care will be threatened as previous cuts to Medicare have already caused oncology practices to close, consolidate and turn away Medicare patients. ASCO is closely monitoring the situation, and advocating on behalf of oncology practices and patients. This week, ASCO placed print…

Rationing Medical Care Part II Clinical Bioethics

Efforts to encourage (or compel) physicians to lie to their patients were faced years ago when “gag clauses” were inserted into contracts between HMO’s and contracted physicians. The gag clause established a contractual obligation on the part of the physician to withhold information regarding treatment modalities that were not within the HMO protocol of allowable categories of care.  Contractually, it is common to exclude specific types or categories of care – “We will pay for this, we won’t pay for that.” Every contract of insurance has exclusions. Gag clauses, however, go further. They contractually bar physicians from fulfilling their fiduciary duties…

Red Flag Rules and the Practice of Medicine Abandonment

Red Flags Rules require financial institutions and businesses that give credit to consumers to establish some sort of program or procedure to identify customers who may be involved in identity theft. Since most medical providers provide medical services and allow the patient to pay their bill at a later time, and in concert with insurance benefits, the FTC intends to treat medical practice as a “creditor” and thus come within the scope of Red Flag rules. “Creditor” is defined by this law as any business or organization that defers payments for goods or services.”     On May 21, 2010…

Publically Managed Care found to be Superior to Private Managed Care Clinical Bioethics

Boston University School of Public Health researchers reported that older, male patients receiving care from the Veterans Health Administration (VHA) health care systems had better health outcomes than those in privately managed care plans that are part of the government-run Medicare Advantage program using private contracted managed care.    Two surveys were done on 107,300 men, ages 65 and older, between 1999 and 2003.   VHA care was found to be more effective that the privately contracted Medicare Advantage program. This was true for the average elderly male patient cared for in the VHA as well as for vulnerable sub-populations."…

Death Panels and Advanced Care Planning Autonomy

A recent article in the Journal of the American Medical Association, JAMA, discusses the need for effective public health announcements to encourage people to explain their end of life wishes and their values, goals and preferences. It has been well established that physicians are reluctant to discuss end of life choices with their patients and the norm has been to put it off until the patient is in advanced terminal disease when it is, indeed, more difficult to discuss. Studies have also shown that the majority of patients said they would choose to forego futile care but few are presented…

Pay to Play – Cost Containment by Ethics Committees Articles

The Los Angeles Daily News, July 11, 2009, wrote, “One doctor, who chairs the Northridge Hospital Ethics Committee, did raise the important and relevant issue of excessive, costly, end-of-life care that has no potential for significantly extending life. If consumers had to pay a significant copayment, they might not demand unreasonable or unadvisable care." http://www.dailynews.com/editorial/ci_12817975 If this physician actually said this, of which I am doubtful, then it must be pointed out that a decision to terminate life sustaining treatment based on or informed by economic considerations is unethical and of great concern. Discussions of terminating life sustaining treatment must…

Life, for some in Texas, is Cheap Abandonment

HEALTH AND SAFETY CODE CHAPTER 166.039. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF COMMUNICATION For the most vulnerable patients, without friends or family, life for some medical patients in Texas, is cheap.  On vague and specious grounds and without proper oversight or transparency, physicians may withdraw life sustaining treatment from a patient, even if the patient is conscious, talking, and aware of his or her surroundings. This statute allows this to occur if a physician treating the patient concludes that the patient will die within six months and there is no…

Randomized Pediatric Clinical Drug Trials – Africa and America Articles

In 1996, Pfizer needed a randomized trial for a new broad spectrum antibiotic and sent a team of its doctors into the Nigerian slum City of Kano during a meningitis epidemic. It was represented, to be a "humanitarian mission.” A team of Pfizer doctors arrived at the Nigerian camp where meningitis had killed at least 11,000 people.  They set up near a medical station run by Doctors Without Borders who were providing standard treatment. At the Kano Infectious Diseases Hospital, 200 sick children were picked. Half were given doses of the experimental Pfizer drug called Trovan and the others were…